Chris Kresser: There’s a lot there. These are always really heartbreaking cases where we want to do everything we can to help all of our patients but particularly the little ones. Let’s see, he’s 30 weeks, so a little over seven months. Definitely could try reintroducing some solid foods now, and that might be the best option along with continuing with complementary breastfeeding. I think your strategy in terms of introduction of food is good, and I think your idea of getting actual testing for iron is really important because, as you know, you cannot diagnose iron deficiency just from low hemoglobin. I just cannot stand that. Getting iron studies and if iron and possibly even B12 or folate while you’re at it so you can see what the cause of the low hemoglobin is, which could be B12 or folate efficiency. The IRONSmart I’ve been actually getting ready to issue an update on this. It appears that it actually contains some folic acid instead of folate. There is a confusion initially on how it was labeled, but we called the company and did confirm that it contains folic acid, which is not ideal, especially when we don’t know the baby’s status in terms of ability to convert that into active folates. I would lean more towards heme iron supplement such as Proferrin and maybe open the capsule and add it to some food or something like that, but that’s only assuming that he has iron deficiency, which you want to find out first.
In terms of formula, there is a great blogger, Jenny. She’s in the Weston Price community. She’s a great blog called Nourished Kitchen, and she has some good guides like an overall guide to formula options. I agree with the way that she breaks it down. The first thing that you might want to consider is a milk share. If the woman, for whatever reason can’t breastfeed, then you have to use formula, I would put it in this order in terms of preference—the first would be a milk share. There are increasingly, especially in larger cities, there are breast milk donor banks, and you can often even find a healthy mom who’s on a Paleo or Weston A. Price type of diet. Either through a donor bank or just locally in a mother to mother milk share. That would be really the first option. I think the second option is homemade goat’s milk formula because the proteins in goat’s milk are often a little bit easier to tolerate closer to what human milk proteins would be like in terms of their structure. There’s a recipe for a homemade goat milk infant formula in this post that I’m going to—let’s see if I can put it in the chat box right here. So there, I think you should be able to see that. That’s this Nourished Kitchen post. The fourth would be a hypoallergenic formula. If lactose is a problem which we don’t know, there’s a lactose-free formula or organic lactose-free formula. If there is any kind of milk allergy, a casein allergy which is very rare in babies because as you can imagine they wouldn’t have survived in a kind of evolutionary context, you could try the babies’ organic soy formula. That’s not ideal. That’s kind of a last option, but there are a lot of options before you get there and you can check out that blog post to get some ideas.